Attention turning to equal rights fight

Clamor rises for better protection against bias, more medical coverage

People hold signs thanking Gov. Andrew Cuomo during the New York City gay pride march June 26. After that landmark decision, the state could do more to improve the rights of transgender people, advocates say. (Stan Honda/AFP/Getty Images) less

People hold signs thanking Gov. Andrew Cuomo during the New York City gay pride march June 26. After that landmark decision, the state could do more to improve the rights of transgender people, advocates say. ... more

Photo: STAN HONDA

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People hold signs thanking Gov. Andrew Cuomo during the New York City gay pride march June 26. After that landmark decision, the state could do more to improve the rights of transgender people, advocates say. (Stan Honda/AFP/Getty Images) less

People hold signs thanking Gov. Andrew Cuomo during the New York City gay pride march June 26. After that landmark decision, the state could do more to improve the rights of transgender people, advocates say. ... more

Photo: STAN HONDA

Attention turning to equal rights fight

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ALBANY — Gov. Andrew Cuomo has been hailed as a hero by gay and lesbian New Yorkers for helping to push through a historic marriage equality law.

Now, advocates are hoping that he will use his political clout to advance stalled transgender rights legislation.

But they concede it remains a long, uphill struggle.

"New York used to be a leader on these issues, but now we're pretty far behind the curve compared to other states," said Jonathan Lang, director of government projects and community development for Empire State Pride Agenda.

For example, 16 states have passed laws to extend discrimination protection for transgender people, including Massachusetts in November and Connecticut in June. Those states amended existing "hate crimes" statutes to include lesbian, gay, bisexual and transgender people, or LGBT, in a definition of groups given legal protection from discrimination.

A similar bill, the Gender Expression Non-Discrimination Act, has been introduced in the New York state Legislature and has passed the Assembly in past sessions. It has never made it to a floor vote in the Senate, dying in committee.

On the federal level, President Barack Obama signed a law in 2009 that expanded the federal hate crimes law to include any crime motivated by "gender, sexual orientation, gender identity, or disability."

More Information

For further reading

To learn more about transgender issues go to:

World Professional Association for Transgender Health, or WPATH (http://www.wpath.org)

TransYouth Family Allies (http://www.imatyfa.org)

National Coalition for LGBT Health (http://lgbthealth.webolutionary.com)

On another front, a state panel advising Cuomo on Medicaid reform had been discussing, among dozens of suggestions, Medicaid coverage of gender reassignment surgery for transgender patients across the state. California and Minnesota, for instance, provide Medicaid coverage for such surgery.

But after a Sept. 29 New York Post story touched off a firestorm of protest, the proposal for Medicaid coverage of transgender surgery was quietly taken off the table prior to a Nov. 1 meeting of a Medicaid Redesign Team that reports to Cuomo, according to Lang.

"It was unilaterally removed by the health commissioner," Lang said.

Lang said previously productive and cordial meetings with Dr. Nirav Shah, the Cuomo-appointed Health Department Commissioner, turned cold after the Post article. "We were told our proposal would not be considered anymore," Lang said. "We have serious issues with the process."

"It was a very shocking development that we were singled out from all the other proposals and removed from consideration," said Christopher Argyros, a transgender rights organizer for Empire State Pride Agenda and a transgender male.

A state Health Department spokesman, Jeffrey Gordon, said he would not discuss the issue other than to refer a reporter to a public statement previously made by Shah: "Gender reassignment surgery is a fundamentally complex medical issue. No consideration is being given to any change in current state policy and any proposal to have gender reassignment surgery funded by Medicaid would be rejected."

Transgender people often are socially marginalized and many do not go public. As a result, there is not a firm count on the number of transgender New Yorkers and no solid estimates on how much extending Medicaid for gender assignment surgery would cost state taxpayers.

"It's up to the health department to come up with a number," Lang said. The argument he made to Shah was that the state will end up paying a higher price because pre-operative transgender patients are far more likely to be chronically unemployed, drug-dependent, severely depressed and even suicidal if they cannot access the costly genital procedure.

Matt Wing, a spokesman for Cuomo, declined to characterize the governor's position on transgender rights and referred all related questions back to the health department.

But Cuomo has not heard the last of transgender advocates as they urge him to expend political capital once again on a related equal rights issue. In October, the Empire State Pride Agenda presented Cuomo with its Douglas W. Jones leadership award at its annual dinner in New York City for championing gay marriage.

On another front, advocates are lobbying for a change in state health department regulations governing birth certificates. Currently, New York state requires the following proofs to change an applicant's sex designation on a birth certificate: documentation that irreversible gender reassignment surgery was completed and medical records were submitted from the surgeon to the health department; documentation of an extended period of hormone replacement therapy; a letter from a therapist confirming the applicant received counseling.

Advocates are seeking a change in statute that would allow transgender people to change the sex designation on their birth certificate without requiring the irreversible genital procedures of gender reassignment surgery. Advocates pointed to a recent survey that showed less than 5 percent of transgender men and less than 20 percent of transgender women had undergone gender reassignment surgery.

A transition of a transgender person is a continuum of changing genders that can take years or even decades to complete, and can cover a gamut of treatments and procedures from hormones to surgery. Many transgender people do not want gender reassignment surgery, or their health insurance does not cover it and they cannot afford a procedure that costs about $20,000, in addition to the other costly treatments.

Advocates have suggested that the current statute amounts to forced sterilization, since New York policy requires surgeries that typically result in permanent sterilization.

The birth certificate matter is under review, said Gordon, the Health Department spokesman.

"This is a complicated issue," Gordon said. "We have been meeting with representatives of this community on this issue and understand their concerns."

Transgender advocates have proposed a state Health Department statute change that would only require an official letter from a licensed physician, psychiatrist, psychologist or social worker stating that the applicant's gender identity conforms with the gender identity stated by the applicant.

By removing surgical and hormonal requirements for changing sex designations on birth certificates, New York would join other jurisdictions that have updated identity document requirements in line with current medical understanding of transgender.

In 2009, the federal government removed the surgery requirement for changing gender markers on U.S. passports and for Consular Reports of Birth Abroad, which are birth certificates that are issued by the Department of State when a citizen is born outside of the U.S. In recent years, the states of Washington, Vermont and California have removed surgical and hormonal requirements and will change an applicant's sex designation on a birth certificate with an official letter from a licensed medical professional.

Transgender people in New York can currently change a sex designation on a driver's license without surgery or hormone requirements, which is similar to the process of changing gender on a federal Social Security card

"Your birth certificate speaks to the core of who you are as a person," Lang said. "It would be incredibly validating to make the statute change and it would improve the quality of life for so many transgender New Yorkers."

Lang added that the birth certificate statute change would be budget-neutral, a key factor in a time of growing state deficits.

"We are going to step up our efforts on behalf of transgender rights," Lang said.

The Empire State Pride Agenda's honoree can expect accelerated lobbying on transgender rights. It was Gov. Cuomo, after all, who spoke these words at the advocacy group's annual dinner on Oct. 27 when he accepted his leadership award:

"And the question that we posed to the people of the state is, do you support equality. Period. That's the whole question, and there's only one answer to that question, which is yes. I support equality. ... Now, we are going to try with the rest of the equality agenda."

Transgender: A special report is a comprehensive look at a largely hidden social issue. For additional reading on the Web, iPad and your mobile device, check http://timesunion.com or download the Times Union app. You'll find more news stories, first-person accounts, photos and video, as well as articles published in Sunday's Times Union.